Inquiry into preventing child abuse and improving children's health outcomes - Child Poverty Action Group
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Child Poverty Action Group
PO Box 5611,
Wellesley St,
Auckland
Web address: www.cpag.org.nz
TO: Health Select Committee
Submission:
Inquiry into preventing child abuse and
improving children’s health outcomes
Child Poverty Action Group thanks the Council for the opportunity to submit on this
important inquiry. Child Poverty Action Group (CPAG) comprises a group of
academics and workers in the field dedicated to achieving better policies for children.
The aims of our organisation are:
• The development and promotion of better policies for children and young
people.
• Sharing information and connecting with other groups with similar
concerns.
• Elimination of child poverty in Aotearoa New Zealand by 2020
Contact: Donna Wynd, donna@cpag.org.nz
1Child Poverty Action Group submissions
• CPAG submits that preventing abuse and neglect of children,
especially very young children, and improving their behavioural,
health and cognitive outcomes necessitates a commitment to
improving both the level of family income, especially sole parent
beneficiary families, and the security of family income.
• CPAG submits government investment in all children, especially
very young children, must be increased, as per the OECD’s
recommendation (OECD, 2009b). Services must be provided on a
universal basis, scaled with a proportionate increase to alleviate the
hardship of less well-off groups, and address particular needs of
disadvantaged children (The Marmot Review, 2010).
• CPAG submits the government must actively take steps to reduce
childhood poverty in New Zealand consistent with its obligations
under international conventions and the Treaty of Waitangi.
Introduction
[1] Child Poverty Action Group (CPAG) is delighted to have an opportunity to once
again submit on issues pertaining to preventing the abuse of children and improving
children’s health outcomes. With the extensive consultation undertaken for the Green
Paper on Vulnerable Children and the Māori Affairs Select Committee’s Inquiry into
the Determinants of the Wellbeing of Māori children, parliament must by now be
coming to an understanding of the issues around the abuse and neglect of children,
and how best to address them so as to avoid or mitigate them.
[2] CPAG has made submissions to both the Green Paper1 and the Māori Affairs
Select Committee2 and, along with others, has argued that the single biggest risk
factor for childhood abuse and neglect is poverty and socioeconomic inequality.
While the present government has sought to keep poverty off the political agenda as
a topic of discussion, no sensible discussion of childhood abuse and neglect can take
place without acknowledging the role of whanau and community poverty.
[3] CPAG acknowledges the importance of the first three years of a child’s life. We
are however concerned that a focus on improvements to early childhood services will
result in cuts to other children’s services. In CPAG’s view this would be unfair,
unethical and short-sighted. If the Committee and the government genuinely wish to
improve New Zealand children’s outcomes, a broad-based approach to child and
parental welfare is required, as is additional funding for children and families.
1
http://www.cpag.org.nz/assets/Submissions/CPAG%20GPVC%20Submission.pdf
2
http://www.cpag.org.nz/assets/Submissions/Submission_WellbeingOfMaoriChildren.pdf
2[4] Much of the information in this submission comes from the recent report from the
Growing up in New Zealand longitudinal study second report.3 This focuses on the
first nine months of childhood and thus addresses many of the issues in the Terms of
Reference for this inquiry.
Terms of reference
[5] The Terms of Reference for this inquiry are wide-ranging and cover multiple
areas requiring specialised knowledge. While factors improving outcomes for children
have largely been identified in research, significant barriers are multiple and vary
from family to family. These barriers may be income-related, social, education and
knowledge-related, family difficulties, or poor health. There is no one answer to
addressing these barriers, and as we note below, the evidence suggests the best
way to improve outcomes for children and identify at-risk families is the provision of
universal and proportionate universal services where possible.
[6] Similarly, advising on practical improvements to services involves knowledge of
the services presently available and how they may or may not be working to benefit
families. In some cases, for example the availability of early childhood care and
education facilities in low-income neighbourhoods, there are obvious gaps. For
others such as wellchild services, these (if they exist) are far less obvious to those
outside the sector in question.
[7] This submission will focus on broad income-related issues as poverty and low
income have clearly been identified as a risk factor for both children and parents,
especially sole parents reliant on benefits with little social support.
The link between poverty, abuse/neglect and childhood wellbeing
[8] The link between poverty and child abuse and neglect has been extensively
researched and documented over many years (Besharov & Laumann, 1997; Gordon,
Kaestner, & Korenman, 2007; Wood, 2003). The Besharov (1997) paper includes
research dating back to the 1970s that identifies the link between poverty and child
abuse, and notes:
“we fail to recognize the overlap between what we now label as child
maltreatment and the conditions of poverty-especially among families headed by
single mothers. Society should cease treating disadvantaged families as if they
suffer from some form of psychological deviancy and, instead, should develop
intervention strategies that better address their broader problems.”
[9] Similarly, Wood (2003) notes “Poverty and the culture surrounding it have a
significant and pervasive impact on the health and development of children.” It is not
poverty and material deprivation alone that impacts on children, it is the associated
stigma and discrimination as well (Sanders-Phillips, Settles-Reaves, Walker, &
Brownlow, 2009).
3
www.growingup.co.nz
3[10] It is important to note that not all or even most low-income families abuse or
neglect their children, and not all at-risk children live in poor households. However,
the evidence shows there is a link between poverty and inequality and child
abuse/neglect. What is far less clear is the pathways through which abuse and
neglect occur, although increasingly research points to the presence of other
stressors within the household as having an impact (Cyr, Euser, Bakermans-
Kraneburg, & Van Ljzendoorn, 2010; Jenson & Fraser, 2011; Wood, 2003).
[11] A key factor in early childhood wellbeing is maternal mental health. Maternal
ante- and post-natal depression can affect the mother-child relationship and the
child’s emotional, social and cognitive development (Milgrom J, Westley D, &
Gemmill, 2004; Murray & Cooper, 1996). Risk factors for perinatal depression include
(but are not limited to) major life events, low income, less education, a history of
depression, a history of abuse, and low levels of social support (Leigh & Milgrom,
2008). New Zealand research has also highlighted the importance of a mother’s
education, income and employment for a child’s pre-natal development (Morton et
al., 2012, p. 11).
[12] Morton et al (2012) report that half of the families participating in their study
had been forced to buy cheaper food to meet other costs; 18% reported being cold in
order to save on heating costs; 13% had used foodgrants or foodbanks and about
the same percentage had gone without fresh fruit and vegetables (Morton et al.,
2012, p. 13). Although the participants in Morton’s study were from across the full
socioeconomic spectrum, there was relative under-representation of families from
deciles 7-10 (ie low-income households), and over representation of families from NZ
deciles 1-6 (ie higher income households) (Morton et al., 2010, pp. 95, Fig32). Thus
the findings are likely, if anything, to underestimate the numbers in and extent of
hardship among low-income families.
[13] This finding is particularly disturbing given the importance of good nutrition on
a child’s behavioural, health and cognitive development. Fresh fruit and vegetables
also have a role in protecting children from asthma, rhinitis, eczema and infectious
diseases (Ellwood et al., 2001; Hunt, 2004; Nagel et al., 2010).
[14] A further finding of the Morton et al report is that only 14% of families received
income from a single source, while 18% received income from four or more sources.
The report notes: “The costs associated with dealing with these multiple sources of
income, for the family and for those administering income support, warrant further
review” (Morton et al., 2012, p. 13). Combined with the finding in para 12 above, this
finding suggests that for almost one in five families, incomes are insecure, sourced
from multiple agencies, and too low to adequately meet the basic nutritional and
other needs of their children.
[15] This is compounded by government policies that actively discriminate against
the children of beneficiary families on the basis of the source of their parent’s income.
The In-Work tax Credit, worth $60 per week for one to three children and an
additional $15 per week per child thereafter, is not available to parents on a benefit.
Technically (and despite its name), the In-Work tax Credit is a support for the child (it
4goes to the caregiver, not the income earner). As such, it should be available to all
children, regardless of the work status of their parents (St John & Dale, 2012).
[16] The impact of the off-benefit rule and the work hours requirement (20 hours
per week for a sole parent, 30 hours per week for a couple) for both the In-Work Tax
Credit and the Minimum Family Tax Credit is particularly inequitable for Māori and
Pasifika families. Not only have they lost their jobs – and hence their tax credits – at
a faster rate during the recession, if they do work they are also far more likely to be in
low-paid casualised work where work hours can vary from week to week. Thus
redundancy means not only losing one’s job, but also losing the financial support for
the children. Casualised work means families can end up owing money to IRD at the
end of the tax year as a result of overpayments (For a discussion of the inequitable
consequences of the In-Work tax Credit, as well as its general ineffectiveness as a
work incentive, see St John, 2011).
[17] New Zealand’s high levels of income inequality are a factor in our poor child
health outcomes. There is now substantial evidence that children’s health, including
injuries and abuse, have a socioeconomic gradient with children in the lowest
quintiles being the most vulnerable (Craig & et al, 2011; Craig, Jackson, Han, &
NZCYES Steering Committee, 2007; Craig, McDonald, Reddington, & Wicken,
2009).
[18] A recent study by Dr Michael Baker found that reported rates of
hospitalisation for infectious diseases “increased from 20·5% of acute admissions in
1989–93, to 26·6% in 2004–08…clear ethnic and social inequalities [were evident] in
infectious disease risk. In 2004–08, the age-standardised rate ratio was 2·15 (95% CI
2·14–2·16) for Māori (indigenous New Zealanders) and 2·35 (2·34–2·37) for Pacific
peoples compared with the European and other group. The ratio was 2·81 (2·80–
2·83) for the most socioeconomically deprived quintile compared with the least
deprived quintile. These inequalities have increased substantially in the past 20
years, particularly for Māori and Pacific peoples in the most deprived quintile” (Baker
et al., 2012). Dr Baker noted that the common factor among the increase in hospital
admissions was poverty. The paper also noted that while hospitalisation rates for
infectious diseases had been falling in other developed countries, New Zealand was
unusual in recording an increase (Baker et al., 2012) over the period of the study.
[19] CPAG suggests that perhaps rather than talking about Māori child abuse, the
conversation needs to turn to the high rates of poverty, unemployment and social
dislocation experienced by many Māori whanau.
[20] Low and insecure income are significant household stressors and are
correlated with high levels of child abuse and neglect. Material deprivation, even
where no abuse is present, can impede children’s development. There is no doubt
that income inequality also impacts on children’s health and wellbeing.
[21] CPAG submits that preventing abuse and neglect of children, especially
very young children, and improving their behavioural, health and cognitive
outcomes necessitates a commitment to improving both the level of family
5income, especially sole parent beneficiary families, and the security of family
income.
Service provision
[22] Universal provision of services to enable identification and targeting of
vulnerable families. CPAG submits it is important to consider children’s services on a
universal basis as the evidence suggests this is the most efficient and effective way
of ensuring children get access to them (OECD, 2009a). The key risk in targeting
selected groups, as the Terms of Reference suggest, is that it will miss the broader
need to create an environment wherein all children have equality of opportunity, and
from within which to identify children’s multiple needs (especially Māori children who
may have multiple disadvantages). In addition to basic universal services there
needs to be proportionate universalism for additional, more specialised, services as
described by Sir Michael Marmot (The Marmot Review, 2010). Here, universal
services are scaled with a proportionate increase to alleviate the hardship of less
well-off groups, and address particular needs of disadvantaged children. “Focussing
solely on the most disadvantaged will not reduce health inequalities sufficiently. To
reduce the steepness of the social gradient in health [or education, or ECCE], actions
must be universal, but with a scale and intensity that is proportionate to the level of
disadvantage” (The Marmot Review, 2010, p. 15). In New Zealand school decile
funding is an example of proportionate universalism.
[23] Such a system of funding would be a great deal more equitable than current
policies which increasingly seek to target high needs groups. Experience from the
justice sector suggests that this approach not only fails to improve outcomes for the
targeted group, but fails to provide services for others who may need them,4
because targeting of high need families misses many of them. New spending on
children must be an imperative if the Committee and the government is to improve
outcomes for New Zealand children, and reduce rates of abuse and neglect.
[24] CPAG submits government investment in all children, especially very
young children, must be increased, as per the OECD’s recommendation
(OECD, 2009b). Services must be provided on a universal basis, scaled with a
proportionate increase to alleviate the hardship of less well-off groups, and
address particular needs of disadvantaged children (The Marmot Review,
2010).
Legal obligations
[25] CPAG reminds the Committee of New Zealand’s obligations under the UN
Convention on the Rights of the Child, which we submit ought to inform any
recommendations made as a result of this inquiry. The Convention places a positive
obligation on governments to provide for the material wellbeing of children in manner
4
Kim Workman, pers comm, 2011.
6that does not discriminate against any one group. UNCROC specifies at length states
parties’ responsibilities, including:
• Article 2: that they shall respect the convention without discrimination of any
kind;
• Articles 3 (1) In all actions concerning children, ….the best interests of the
child shall be a primary consideration. (2) States Parties undertake to ensure
the child such protection and care as is necessary for his or her well-
being,…and, to this end, shall take all appropriate legislative and
administrative measures;
• Article 24 (1) “States Parties recognize the right of the child to the enjoyment
of the highest attainable standard of health and to facilities for the treatment
of illness and rehabilitation of health. States Parties shall strive to ensure that
no child is deprived of his or her right of access to such health care services.”
• Article 26 (1) States Parties shall recognize for every child the right to benefit
from social security, including social insurance, and shall take the necessary
measures to achieve the full realization of this right in accordance with their
national law
• Article 27 (1) States Parties recognize the right of every child to a standard of
living adequate for the child's physical, mental, spiritual, moral and social
development.
• Article 27(3) States Parties, in accordance with national conditions and within
their means, shall take appropriate measures to assist parents and others
responsible for the child to implement this right and shall in case of need
provide material assistance and support programmes, particularly with regard
to nutrition, clothing and housing.”
[26] Similarly, the government is bound by the Treaty of Waitangi. A
disproportionately high number of Māori children are living in poverty, have parents
on a benefit, and have accordingly adverse outcomes It will take extraordinary efforts
to rectify these disparities among children, and CPAG hopes the Committee is willing
to address these efforts.
[27] CPAG submits the government must actively take steps to reduce
childhood poverty in New Zealand consistent with its obligations under
international conventions and the Treaty of Waitangi.
7References
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